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Enhance your prospective program with accurate condition analytics

Generate more value out of your prospective risk adjustment program by using AI to identify accurate condition recaptures & suspects and drive higher provider acceptance rates.

Prospective Chart Review

Prospective Analytics: AI-powered condition suspects & recaptures

Risk adjustment teams face internal financial pressure and growing regulatory pressure to move away from retrospective chart reviews for Medicare Advantage. To maximize patient engagement, reduce provider abrasion from retrospective reviews, and facilitate more accurate risk capture upstream, many organizations are implementing prospective programs that equip physician offices with information to improve condition coding, support care gap closures, and develop a more holistic view of patient heath. But developing an accurate, actionable list of condition opportunities is time-consuming and complicated.

Apixio’s Prospective Analytics solution uses AI algorithms to generate a list of suspected & known risk-adjusting patient conditions, powering your prospective program with reliable, targeted intelligence.

Prospective activities we support

Generation of suspected conditions
Member engagment & scheduling
Pre-visit chart grooming
Point-of-care documentation

Benefits for plans and providers

For Plans

  • Higher physician acceptance rate with condition suspects
  • Reduced physician abrasion from irrelevant suspect data
  • Earlier, more accurate reimbursement for population risk
  • Streamlined retrospective reviews and in-home assessments

For Providers

  • Reliable condition suspects with supporting documentation for review
  • Improved risk capture and care gap closures during patient encounters
  • Increased incentive payments from prospective risk programs
  • Fewer chart retrieval requests to support health plan retrospective reviews
Explore how Apixio can power your prospective risk adjustment program.